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Claire Lemer has a bespoke role as a Consultant in General Paediatrics and Service Transformation at the Evelina London Children’s. Sadly, she was also involved in a road traffic accident late last year, and has reflected on this patient experience of navigating the NHS. Consequently, Claire has a truly unique experience and understanding of the NHS.

At our recent Health Foundation hosted Running Horse Group meeting Claire gave a brilliant overview of the key issues currently facing paediatrics, managing to bridge shop floor clinical issues with ‘big-picture’ strategic challenges. It’s easy to forget to stop and take stock of the current status quo and Claire clearly articulated a number of key issues

The narrative around children and young people

There’s been a huge drive to link up adult health and social care. Despite significant funding, many believe even more investment is needed. Yet the pathways for children and young people (CYP) are equally as bad, if not worse compared to adult services. Efforts to fund a joined-up health and social care service for CYP must be given higher priority.

This seems obvious to those working in the ‘front line’ of child health, but the difficulty is how we go about achieving it. The first step will involve ‘selling’ the need for integrated health and social care, and this requires us using the correct narrative. CYP are forever being forgotten when it comes to policy and funding decisions, and we need to be clear about how we develop the correct framing around their needs in health and social care. We’ve already mooted proposals using the ‘moral’ need, the ‘quality’ perspective, and even backed this all up with economic evidence. Yet still we struggle to get CYP on the policy table. It’s time to examine exactly why this is, and start thinking outside of the box as to how we present CYP in future strategic health care decisions. This involves directly speaking to CYP themselves, something which all parties have been woefully poor at doing until the last couple of years.

Empowering young people

Claire described an interesting healthcare analogy using a well known coffee shop as an example of how consumers are actively involved in the service process. The barista hands you a coffee and points you to the sugar, milk and napkins. By creating a system where the customer does more, the barista can do less, and customers are served faster. Overall the service is more efficient.

So what could we learn from this Starbucks model, and how could we deliver something similar for young people, especially those with long-term conditions? This is not glib business translation as young persons persistently say that want to be more involved and engaged in their own care. It’s important that we design our services in a way that empowers young people, offers them more choice over their care, and promotes health-protecting behaviours as they transition to adult care. We may think we do this, but we probably don’t do it as well as we think we do.

Using information technology

Health care for CYP could be doing much more to embed information technology into its services. We need to be clear about how this will happen and how we can ensure it promotes integrated, more efficient care. The Red Book for example, will soon become digital. But have we considered who will hold it? Will this be the parent/carer or the child? We need discussions exploring the age at which a CYP starts to take control over their own health records, and how we can best promote this assumption of responsibility within our health care service.

Secondly, we’re far too linear in our thoughts about information technology. We need to be more radical in how we embrace it, ensuring we have CYP input from the start. By designing the right systems, we are much more likely to get widespread uptake and better engagement of CYP with their health.

Structured change

With the recent merger of NHS Improvement and NHS England, regional level stakeholders are key to addressing CYP’s presence on local agendas. But how does this play out in terms of CYP services within sustainability and transformation partnerships (STPs)? To what extent are CYP issues addressed in STPs and the new Integrated Care Systems (ICSs)? What has promoted or hindered this work locally?

With integrated care comes assessment and analysis of impact. At present, there’s very little work assessing the impact of integrated care on children’s services. There are huge learning opportunities here, not only to support the faster spread of successful integration to other regions, but also to understand what’s working to address the inequities within CYP care, and what is not.

Ethics

It’s a complicated and sensitive issue, but we are long overdue a review of where the UK stands ethically with regards to palliative conditions for CYP. With recent high-profile cases fresh in our minds, it’s important to assess not only the impact on CYP and their families, but also the effect on staff. Continuing with the current position is likely create significant moral pressures on the future workforce, detrimental to the care we provide for CYP.

The challenge of addressing these issues discussed above hinges on the fact that we lack an overall framework for CYP. There are multiple organisations advocating on behalf of children, but we don’t speak as a united voice, nor operate under a unified umbrella organisation. We need to identify key strategic areas that can be targeted to achieve political traction, and build upon this.

We considered Claire’s insights in group discussions and this led to a mapping of the key issues that the RHG felt were facing paediatric care in the UK. The honeycomb model below has attempted to cluster the issues into some key topics.

The rest of the afternoon developed on the learning from this session. After hearing about projects from RHG members, it was clear that there are key issues that we have focussed our efforts on; namely staffing and morale, and models of care.

It’s interesting to think about why these two areas have received so much input by RHG members. One idea is it we feel able to proactively address these issues locally as front-line clinicians. Alternatively, it could it be that as these problems culminate, the pressure points on children’s services present themselves as the failure of the current model of care and poor staff retention. This has pushed us into a corner as a service, leaving us with no other option than to try and redesign services ourselves and use novel staff retention strategies.

Moving forward, it’s important to keep the big picture of paediatric services in mind whilst recognising that we might not be able to address many of these issues either ourselves or with our local teams. But for those areas that we are trying to improve, the RHG network is a suitable place to better share successes, and study challenges, identified in our own projects.

It’s been a long time since the Running Horse Group has been active. Life, as is said, can get the better of you!

Inspiring the child health workforce to deliver high quality services that delight children and families

Since its inception, those involved the Running Horse Group have been passionate about improving the quality of care for children. However while social media and the digital era has made the world a much smaller place the ability to actually meet face-to-face seems to have become progressively harder.

The Health Foundation have kindly donated us a room in their Convent Garden offices on 25th May from Midday onwards. In conjunction with Dr. Susannah Pye (the National Medical Director’s Clinical Fellow at the Health Foundation) we’ve put together a programme to consider the past, present and future role of the RHG. There will be presentations from the improvement team at the Health Foundation, with a specific look at what’s been happening across the UK in relation to paediatric services. It’s going to be an opportunity to explore what can be achieved as a network of professionals interested in child health focused on leadership and management.

If you are interested in attending please do e-mail me at damianroland@me.com. This is an opportunity to step outside our hectic lives and take stock of bigger picture items which may be impacting on our services. Hopefully people will be able to stay around for evening drinks and food afterwards as well 🙂

On the 7th July the RCPCH are hosting an event to promote ‘real life’ quality improvement. You will have the change to take part in a virtual quality improvement exercise and pitch quality improvement ideas in a Dragon’s Den Event. There will be patient experience and parent perspectives as well.

Delegates will leave the conference with an understanding on:

how to introduce concepts of patient safety and QI in paediatrics and child health with a multidisciplinary, patient-centred focus

putting patient safety in paediatrics and child health in context with quality improvement

putting together a team and starting a QI project with a focus on improving patient safety

working with colleagues to create an aligned, patient-safety focussed QI structure, in line with the RCPCH QI Strategic Framework.

The conference will also provide delegates with an opportunity to learn about a number of local, regional and national quality improvement projects.

Delegates will hear from leading speakers in paediatric health QI, plus enjoy a choice of workshops, including:

Medication safety

Situation awareness

Engaging patients/families in improving care

Foundations of QI

Human factors in patient safety.

Poster competition
The conference also provides an opportunity for delegates to enter the Safer In Our Hands poster competition. Submitted posters should demonstrate locally developed and implemented quality improvement projects that have resulted in demonstrable improvements in safety.

Delegates wishing to enter a poster for the conference competition should submit an abstract to qi@rcpch.ac.uk by Monday 13 June, and successful delegates will be notified by the end of that week if they have been successful.

Thank you to all those who attended the recent get-together. It was a brilliantly diverse crowd ranging from paediatricians to technologists, and from parents to managers.

My sincere apologies as the following is not as comprehensive as it could (or should) have been but hopefully gives a sense of what was discussed and debated. It is clear to me other mechanisms need to be found of bringing people together and in the time available we didn’t have time to get to the thorny question of what is the RHG and how do we sustain it!

I am inspired (and a little bit humbled) by the closing comment of one of the participants though:

“It is fantastic to see a group of people motivated to make the system better”

Afternoon Meeting

This essentially involved a round robin of idea generation. Some of the themes:

A. Can and how do we use Big Data for patient experience?

B. How do we improve our interaction with our patients (on top of being better communicators). Can we crowd source technologies to improve this? Do we really understand how “apps” are utilised by patients/public?

Listening to a paediatric surgeon describing how they use a iPad with a minions game to distract and entertain during consultations
#rhg15

If the list above triggers ideas or suggestions please do get in touch! Ian Hennessy shared his experience of Alderhey’s recent Hack with MIT. While ‘hacks’ are all the rage the focused nature of this event with clear Chief Executive backing demonstrates what can be achieved in 36 hours.

Evening Meeting

This essentially focused on logic models and was skilfully facilitated by Bob Klaber. The discussion focused on patient experience and outcome and the experience of those parents of children with chronic and complex needs was very beneficial. Looking through the lens of “Avoiding unnecessary suffering or harm” appears to be a good way of determining the relevance of various facets of a model. Should all logic models be ‘visceral’ in their production?

There was some discussion on whether Right Place, Right Time and Right Person was meaningful. Should it be Equitable place, Safe time etc..

The UK and European model of paediatricians vs GPs vs Community Paediatricians was debated as was access to data. A great quote I heard from the #MedX conference was “why do cybercriminals have easier access to my data than I do”

I asked people to sum up some of their learning or thoughts from the day. A selection of the quotes:

“Makes me feel I really need to sort out the little things”

“Importance of story telling”

“Power of having non-clinicians in the room”

“The most authentic socialism I have come across”

Sorry this is not a more detailed summary but at some point in the new year I will do a further call to find a mechanism to bring people together again to discuss objectives and strategy.

Thank you to IBM for hosting the afternoon event, Thinking of Oscar for assistance in organisation and all those who attended and contributed so enthusiastically!

First off an apology for the quiescent nature of blogs and output over the last year. Juggling numerous responsibilities and dealing with ever increasing service pressures I hope is not a unique experience.

However a meeting date has been set for the next RHG get together: November 23rd

The day will start at the IBM Southbank Centre from 2pm. Places will be limited for this phase of the day so if you can e-mail me to confirm asap I would appreciate it. There will be a few keynotes and opportunities to influence innovative work going on around the country.

In the evening there will be a working dinner with a chance to exchange thoughts and share some ideas. It’s fine just to join the evening event.

A lot has yet to be confirmed (including location for dinner) although I am aware no-one is interested in coming to another ‘talking shop‘. For those who have been involved in the RHG since its inception I think (hope!) the network has provided a safe and valuable space to discuss and debate. I’m probably not going out on a limb by guaranteeing if you have a problem we can find you someone who has solved it.

I also appreciate it is yet another London-centric event. Without a funding stream and a need for hosts willing to operate at no cost, with no guarantee of attendance, options are limited. I am always open to other suggestions for the future though!

The Running Horse Group had an inaugural meeting on the 6th July 2010 (in the Running Horse Inn, London). This meeting was an attempt to address the perception that those most affected by the future delivery of Child Health Services appeared to be least engaged in its evolution. The following points were made:

Child Health (the delivery of care across all services, populations and areas) is a different concept than that of just “Paediatrics”.

Clinical Leadership in Child Health is an important area for development

Expectation of the future role of the trained Paediatrician must be managed as this will have important repercussions on recruitment into the specialty.

The focus of the group quickly changed from one of workforce planning to one of quality improvement and cultural change leading to the development of our current ‘mantra’

Inspiring the child health workforce to deliver high quality services that delight children and their families

A great deal has happened in the last 5 years but it is fair to say the RHG has been quiescent recently. There are a variety of reasons for this but it is clear that the ethos and concept of the group are still very much in the minds of many organisations and individuals. The time has come to look at another 5 year plan but more importantly re-energise our membership.

In the summer we hope to hold an event where we can discuss where the RHG stands and more importantly continue to reach out to anyone who is interested in our aims. This includes a new generation of paediatric trainees who have the passion to look outside the current paediatric curriculum but more importantly other medical specialties and health care professions. The worst thing that could happen to the RHG is that it becomes an exclusive club. It should be open to all and with the Foundation of Child Health put on hold there is a clear need to bring professionals, parents. children and young people together in other ways.

Please look out for further announcements but in the mean time please encourage others to join (by following this website). If you get a chance also have a look at the #ReACT website – an open repository of resources based around identifying the deteriorating child. Maybe share the following two videos? It’s possible you might save a life by doing so…